Eating Disorders

We live in a world with people of different shapes and sizes as well as society telling us to look a certain way. When we feel pressures from family, friends, and the media, we feel the need to change our bodies so that we do not face bullying or being different for looking the way we do. This causes us to take drastic measures to change our bodies the way we think society wants us to look which can cause body dysmorphia or eating disorders if we are not careful. There are a number of reasons as to why we feel the need to change the way we look and they are all around us. According to a study in Peer, Parent, and Media Influences (p.54-60), in youth from ages 9-14, the media plays a strong role as an influence to change your body. Your favorite model or actress can be skinny with no flab, acne, or blemishes to show. The National Association of Anorexia Nervosa and Associated Disorders says 69% of female youth from grades 5th-12th grade feel images in magazines can affect their perception of what they wished their bodies looked like. According to a study done in Teens, Social Media, and Body Image, 47% of them want to lose weight because of those images. Boys want to have a muscular, toned look and girls want low body weight. Magazines that encourage a healthy lifestyle like yoga or natural living use models that have a ‘perfect’ physique and are unnaturally thin. In other careers such as law, medical, and the military, use models for their ads who all look flawless and skinny. The best ways to help accept yourself for who you are is to change the way you look at these influencers. When you are at the grocery store and you see all of these magazines of "beautiful people," you can either choose to ignore them or go to a checkout lane with no magazines. Remember that not everything you see in the magazines are even real. Many magazine publishing companies use Photoshop to retouch photos to make these women look skinnier with shiny skin. It also helps to make a list of all of the great things about yourself that make you beautiful as we all have a list of qualities that make us stand out from the rest. It is also important to tell yourself that we were all created differently and that looking like a model is not what the general population looks like.

Body Dysmorphic Disorder (BDD) is more than a body image issue. It is normal to feel a little conscientious about the way you look whether you wish you had a smaller nose, a tighter stomach, or have smooth, wavy locks. We may think about these things sometimes or when special occasions come up. People with BDD, on the other hand, think of real or imaginary flaws for hours daily, causing severe emotional distress. Distracting thoughts can leave those with BDD missing work or school, avoiding social situations, and isolating themselves because they are ashamed of letting their flaws go noticed. This can involve spending thousands of dollars in plastic surgeries and still never being satisfied with the results. BDD is not to be taken lightly as this disorder can ruin your health and your social life.

Eating disorders are a behavioral health issue.  Eating disorders include bulimia, anorexia, and binge eating disorder. All three can have emotional, behavioral, and physical effects on the individual and can even be life-threatening for both males and females. Eating disorders such as anorexia nervosa are a behavioral health issue in addition to being much more.  A person with anorexia will go to great lengths to hide their weight through wearing bulky clothes or pretending to eat food even when they are not.  Calorie restriction is common with anorexics and the daily number of calories is far below the recommended daily requirement.  Additionally, the anorexic will exercise excessively throughout the day and may take laxatives or diuretics to keep from gaining weight.  An anorexic has an underlying fear of gaining weight and a distorted body image.  They see themselves as overweight even when the scale puts them within a normal range for their height. A person with bulimia can consume over 10,000 calories per day.  The behaviors associated with consuming this amount of food includes shopping for the food and hiding the food from family members.  With bulimia, another behavioral health issue is the purging that occurs following consumption of food.  Bulimics can experience health-related issues such as an inflamed esophagus or tearing of the throat lining.  There is a great deal of dishonest behavior that occurs with bulimics including lying to family members and friends.  They too will go to great lengths to hide their behavior. Binge-eating disorder is also known as compulsive overeating.  Individuals will consume large amounts of food on average two times per week for six months or more.  The person with this disorder will have difficulty in stopping the behavior, once started.  Mental health issues are commonly present including depression and anxiety. There are biological, psychological, and social factors at play with eating disorders.  A person can have a hormonal imbalance, which causes the overeating.  Psychological factors include low self-esteem, depression, lack of control over life in general, and an inability to experience healthy expression of emotions.  Eating disorders are commonly seen with those who have been sexually abused or who experience social pressures from peer groups and the media to look a certain way.

Food addiction recovery is hard to understand. Someone is out of control, completely unable to manage and regulate their consumption of food. When someone is addicted to drugs and alcohol, there is talk of abstinence in their recovery. An addict or alcoholic has a unique inability to manage and control their drinking or drug use after the first drink or use of the drug. For their recovery it is suggested they abstain from drugs and alcohol in order to avoid that first drink or drug. What about food addiction? Food addicts cannot abstain from food. Food is vital for survival, physically and psychologically. For food addicts, their temptations don’t lie only in special places or obscure street corners. Food is everywhere. Restaurants, grocery stores, gas stations- the temptations to eat and overeat and abuse the body with food is everywhere. It isn’t so black and white. Alcoholics don’t avoid everything to be drank. After all, water is necessary to survive and it's arguable that humans are addicted to water. However, alcoholics have to choose not to drink alcohol or any beverage that would trigger their cravings for alcohol. Likewise, food addicts don’t avoid all food at the risk of relapse because that would be irrational. According to Food Addicts Anonymous, abstinence is defined through a series of dietary choices and behaviors. For example the FA program includes weighing and measuring portions in a specific way which is explained in their dietary guidelines. Like most healthy eating programs, FA suggest square meals a day, though no food in between. Most importantly, the FA guidelines suggest avoiding trigger foods like flours, sugars, and binge foods. Sugar is highly addicting and most simple carbohydrates that include flours include a lot of sugar- but carbohydrates are sugars. Binge foods are different for everyone, but can often include things that munch and crunch, snacks in bags, and food that food addicts find it difficult to stop eating. Recognizing that their addiction to food can be likened to drugs and alcohol, people in recovery from food addiction adopt a recovery lifestyle which includes abstinence, treatment, therapy, and often 12 step participation. In time, they learn about what triggers their food addiction, relapse prevention techniques, and healthy living lifestyles for long term recovery.

It is a remarkable and wonderful feat of technology to be developing the field of telehealth or e-therapy. Everything from chat rooms, smart phone apps, and artificial intelligence “bots” on social media messaging platforms are providing proven therapeutic techniques to those in need. Therapy is not accessible by everyone and can still be effective when it is not done in person- depending on the diagnosis. New research suggests that for binge eating disorder, in person therapy is the most effective in promoting remission. Published in JAMA Psychiatry, the University of Leipzig Medical Center found that “...while an internet-based self-help program did help people binge eat less often, face-to-face therapy led to a larger and faster reduction in binge eating episodes,” reports Reuters. In person therapy proven to be the most effective of binge eating disorder includes cognitive behavioral therapy and traditional psychotherapy. Though the online therapies being offered are based on cognitive behavioral therapy, they are not the same as cognitive behavioral therapy which can be conducted in person by a professional therapist. Binge eating disorder is the most common of eating disorders and one of the only eating disorders more heavily populated by men. Though the diagnosis is new to eating disorders, the experience of uncontrollable eating is not new to those who have been struggling with it. This study proves that spending time in a treatment program where you can work with a therapist, multiple therapists, in person every day is a better chance at full recovery. In addition, there is another face to face component of treatment that is helpful for recovery: supporting peers.

You’re hungry, so you eat. You eat until you are full and then you stop. Sometimes, you might eat a little more than you really should. Feeling full, you might lament about the mistake you made eating so much food, wonder what you were thinking (or what you weren’t thinking) and vow not to do that again. It’s possible that you compensate. Maybe you take a pill, you change your diet the next day, or you spend extra time at the gym. This is all relatively normal. Now, take it to the extreme. You’re hungry and you start to feel paralyzed by anxiety that grows every time you get hungry. You get anxious when you’re hungry because you know there is a very real possibility that once you start eating you won’t be able to stop. You eat. Then you eat some more. You don’t stop eating until you feel so full you’re actually in pain. You don’t feel a little bit bad you ate so much. Intrusive and obsessive thoughts about what you’ve done, how horrible you are for doing it, and how you should punish yourself for it start to cloud your mind along with the euphoria of feeling so full. However, the euphoria is short lived because you are quickly consumed with overwhelming guilt which drives you to compulsive behavior. Instead of compensating in healthy ways like eating a bit healthier or going to the gym you purge. You purge because you have bulimia nervosa and this is it’s vicious cycle. Purging in bulimia nervosa can take many forms. Some people compulsively exercise, some people abuse laxatives, others induce vomiting. Researchers have tried for years to understand what compels someone with bulimia to participate in the behaviors they do. Recently, two studies in Journal of Abnormal Psychology gave some insight. A brain which has developed bulimia responds differently to triggers of stress with alterations in appetite and a disconnect in satiation. Meaning, people with bulimia have a hard time controlling their hunger and knowing when they’re full. Using MRI, one study found that the brains of people with bulimia have more reward circuitry when it comes to taste. Similar to the way an alcoholics is prone to a binge on alcohol after tasting their first drink, someone with bulimia is prone to a binge on food after their brain responds to the taste of it. As a result, people with bulimia eat beyond their capacity. Then compensate through controlling mechanisms because they feel they have been taken so out of control of their bodies.

“That’s not good,” remarks main character Ellen in the highly controversial Netflix film To The Bone, as she steps off the scale in a morning weighing session at her residential treatment program. Ellen is portrayed by Lily Collins, an actress who has been open about her own struggles with eating disorders. The “not good” she is referring to is her very low weight, which is made obvious by her skin and bone structure. Ellen’s diagnosis is anorexia nervosa. Among all mental health disorders, anorexia nervosa has the highest rate of mortality. Heavy restriction and starvation deprives the body of the nutrients it needs, causing the body to take extreme measures for survival. Eating away at fat until the body eats away at muscle and bone, it will do whatever it has to do to gain its energy back and survive. The main character develops “furring”, a condition of anorexia in which the body starts growing extra hair in order to keep itself warm. Ellen is troublingly skinny. Her anorexia nervosa has gotten extreme and at one point in the movie she is on the brink of having a feeding tube. She also passes out and turns down food when it is offered to her after. Unfortunately, to movie viewers, Ellen is the stereotype of anorexia. She is caucasian, pretty, a female, and comes from a middle to upper class family. In her treatment, there are representations of other bodies and genders with different types of eating disorders. However, as many different articles criticizing the film points out, Ellen’s character represents a small percentage of the way people with eating disorders look. They aren’t always that severe but because that level of severity is what the media chooses to portray, that’s what millions of people believe they have to look like in order to be considered “sick”. One of the most dangerous statements people unknowingly make to someone who opens up about having an eating disorder is, “You don’t look like you have an eating disorder.” If you ask  said person just what an eating disorder is supposed to look like, you would probably get a description of someone like Ellen- emaciated and “to the bone”. Not all eating disorders cause severe weight loss. Bulimia nervosa doesn’t typically contribute to weight loss. Binge eating disorder causes weight gain. Orthorexia is focused on maintaining a “healthy” body. Mild to moderate cases of anorexia might not include severe weight loss either. Part of the problem with this stigma is that the non-severe eating disorders can be hard to find treatment for, despite the chronic stress one experiences mentally as well as physically.

Women have certain rituals, dietary trends, exercise habits and more which they become accustomed to before they get pregnant. Once they find out they are pregnant their dietary and exercise habits can no longer be self-serving. They have another person’s needs to consider. Most women gain weight during pregnancy. For women who might have underlying eating disorder issues they never realized before, the out of control weight gain is very triggering. They feel out of control of their bodies, uncomfortable with themselves, and feeling anxious that they cannot change it. An obsession about their body, size, and appearance is striking to them. Before their body, whatever they did to maintain control over how they looked and how they felt they looked might have not been a conscious issue because there was not shift in their body. Now, pregnant with their child, and with a changing body, they are forced to reckon with  the deep psychological as well as physical discomfort that experience creates.